<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
        
        <div class="layui-form-item">
            <label class="layui-form-label">unionid</label>
            <div class="layui-input-block">
                <input type="text" name="unionid" class="layui-input" autocomplete="off" lay-verify="required" placeholder="请输入unionid" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">店铺id</label>
            <div class="layui-input-block">
                <input type="text" name="shop_id" class="layui-input" autocomplete="off" lay-verify="required" placeholder="请输入店铺id" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">用户支付金额</label>
            <div class="layui-input-block">
                <input type="text" name="pay_money" class="layui-input" autocomplete="off" lay-verify="required" placeholder="请输入用户支付金额" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">用户获得积分数量</label>
            <div class="layui-input-block">
                <input type="text" name="points" class="layui-input" autocomplete="off" lay-verify="required" placeholder="请输入用户获得积分数量" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">支付状态 0:待支付 1:已支付  2:支付取消 3:支付失败</label>
            <div class="layui-input-block">
                <input type="text" name="pay_status" class="layui-input" autocomplete="off" lay-verify="required" placeholder="请输入支付状态 0:待支付 1:已支付  2:支付取消 3:支付失败" value="0">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">发放状态 0:待发放 1:已发放 2:发放失败</label>
            <div class="layui-input-block">
                <input type="text" name="send_status" class="layui-input" autocomplete="off" lay-verify="required" placeholder="请输入发放状态 0:待发放 1:已发放 2:发放失败" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">订单号</label>
            <div class="layui-input-block">
                <input type="text" name="order_no" class="layui-input" autocomplete="off" lay-verify="required" placeholder="请输入订单号" value="">
            </div>
        </div>
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>